Southport & Clinical Commissioning Group Integrated Performance Report August 2014

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Contents 1. Executive Summary ...... 4 2. Referrals ...... 6 3. Planned Care ...... 8 3.1 All Providers ...... 8 3.2 Southport and Hospital NHS Trust ...... 8 3.3 Planned Care Key Issues ...... 9 3.3.1 Southport and Ormskirk Hospital NHS Trust ...... 9 3.3.2 The Royal and Broadgreen University Hospitals NHS Trust ...... 9 4. Unplanned Care...... 9 4.1 All Providers ...... 9 4.2 Southport and Ormskirk Hospital NHS Trust ...... 10 4.3 Unplanned Care Key Issues ...... 10 4.3.1 Southport & Ormskirk Hospital ...... 10 5. Mental Health ...... 11 5.1 Mersey Care contract ...... 11 5.1.1 Key Issues ...... 11 5.2 Key Performance Indicator CPA follow up ...... 12 5.2.1 Improving Access to Psychological Therapies (IAPT) Inclusion Matters Sefton ...... 12 6. Liverpool Community Health Performance ...... 13 6.1 Key Issues ...... 13 6.2 Third Sector Contracts ...... 13 7. Quality and Performance ...... 14 7.1 Southport & Formby CCG Performance Dashboard ...... 14 7.2 Friends and Family – Southport and Ormskirk NHS Trust ...... 19 7.3 Complaints ...... 19 7.4 Serious Untoward Incidents (SUIs) ...... 21 7.4.1 NHS Southport and Formby CCG ...... 21 7.4.2 Southport and Ormskirk Hospital NHS Trust ...... 21

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Tables

Table 1 Patients waiting (in bands) on incomplete pathway for the top 5 providers...... 7 Table 2 All Providers ...... 8 Table 3: Month 4 Planned Care - Southport and Ormskirk Hospital...... 8 Table 4: Month 4 Planned Care - Southport and Ormskirk Hospital 13/14 – 14/15 Comparison ...... 9 Table E: Month 4 Unplanned Care - All Providers ...... 9 Table F: Month 4 Unplanned Care - Southport and Ormskirk Hospital NHS Trust ...... 10 Table G: Month 4 Planned Care - Southport and Ormskirk Hospital NHS Trust 13/14 – 14/15 Comparison ...... 10 Table H NHS Southport & Formby CCG – PBR Cluster Activity ...... 11 Table I- NHS Southport & Formby CCG Performance CPA follow up within 7 days of discharge from psychiatric inpatient care ...... 12 Table J NHS Southport & Formby CCG Performance CPA follow up within 2 days (48 hrs) for higher risk groups ...... 12 Table K PHQ13_6 The Proportion of People who complete treatment who are moving to recovery ...... 12 Table L Serious Untoward incidents NHS Southport & Formby CCG Patients by Trust ...... 21 Table M Reported Serious Untoward incidents - Southport and Ormskirk Hospital NHS Trust ...... 21

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Key information from this report

1. Executive Summary Cdifficile Target - Southport and Formby CCG This report provides summary information on the reported a year to date July 2014 figure of 15 activity and quality performance of Southport & cases against a tolerance of 13. There were 4 Formby Clinical Commissioning Group at August cases reported during the month of July 2014, 3 of 2014 (note: time periods of data are different for the 4 were at Southport and Ormskirk Hospital each source). NHS Trust (2 Acute and 1 Community) and 1 at Hospitals NHS Foundation Trust.

Southport and Ormskirk Hospital NHS Trust has reported 3 new cases in July 2014, taking the cumulative total to 13 cases against a year to date tolerance of 9. All cases are undergoing Root Cause Analysis (RCA).

MRSA - In July 2014, the first 2 cases of MRSA were reported for Southport and Formby CCG

patients for 2014/15, this is against a tolerance of

zero. Both cases have been recorded against Southport and Ormskirk NHS Trust, 1 Trust acquired and the other community. Southport and Ormskirk Hospital NHS Trust has recorded 1 case of MRSA in July 2014.

A&E 4 hour wait - Southport and Formby CCG CCG Key Performance Indicators achieved this target cumulatively to July 2014 with

97.53% against the 95% target. Year to date, of NHS Constitution Indicators Footprint the 16,351 patients attending, 15,947 were seen Ambulance Category A Calls (Red 1) CCG within 4 hours. Performance cumulatively to July RTT 18 Week Incomplete Pathway CCG 2014 at Aintree University Hospitals NHS Cancer 2 Week GP Referral CCG Foundation Trust was below the target of 95% with Percentage of patients who spent 4 hours 91.88 %, a further fall from the figure recorded in or less in A&E CCG June (92.14%) 2014. Year to date, of the 39,091 Other Key Targets patients attending, 35,915 were seen within 4 Ambulance Category A Calls (Red 1) NWAS hours. Key actions are currently taking place to Ambulance Category A Calls (Red 2) CCG review this. Southport and Ormskirk Hospital NHS Trust achieved this target with performance Ambulance Category A Calls (Red 2) NWAS cumulatively to July 2014 at 97.30%, up from Ambulance Category 19 Transportation CCG 97.07% in June. MRSA CCG MRSA S&ORM Southport and Formby CCG have reported 6 C.Diff CCG mixed sex accommodation breaches year to date, C.Diff S&ORM July 2014. All breaches were recorded against Southport and Ormskirk Hospital NHS Trust. Cancer 2 Week Breast Symptoms CCG Cancer 31 Day Radiotherapy CCG Southport and Formby CCG did not achieve the Mixed Sex Accommodation CCG targets in all Ambulance Clinical Quality indicators Mixed Sex Accommodation S&ORM cumulatively at July 2014. For Category A (Red 1 and 2) 8 minute response time indicators. Please RTT 52 Week Waiters (Non-Admitted) S&ORM note the CCG is measured on the NWAS figures which are also under target for the above 2 indicators For Category 19 transportation time, performance was 90.11% for July, giving a year to date figure of 89.96%, below the 95% target.

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Provider Trust Performance Issues Continued ……..

Cancer Targets - Maximum two-week wait for the first outpatient appointment for patients referred urgently with breast symptoms. In the year to date, June 2014 Southport and Formby CCG marginally failed to achieve target, recording 92.36%.

Maximum 31-day wait for subsequent treatment where the treatment is a course of radiotherapy - Southport and Formby CCG achieved 100% during June 2014, but the year to date figure of 93.85% remains marginally below the 94% target. This underperformance is due to the previous month’s figures.

Stroke Indicators - These 2 indicators were both achieved for Southport and Formby CCG patients during July 2014 recording 90%. Southport and Ormskirk Hospital NHS Trust achieved the stroke target of 80% recording 84.62% in July.

Both Aintree University Hospital NHS Trust and Southport and Ormskirk Hospital NHS Trust achieved the 60% TIA target in July, performance was 100% at Aintree and 83.33% at Southport and Ormskirk demonstrating that they are now compliant.

Friends and Family Test Score The indicator comprises two elements: the test score and the % of respondents who would recommend the services to friends and family – for Inpatient Services and A&E. Providers are now measured against these separately and not combined as previously measured.

Southport and Ormskirk Hospital Trust -

• Inpatient test score in July – 70 compared to average of 74

• A&E test score in July – 40 compared to England average of 53

• Inpatient % response rate in July – 37.1% compared to a target of 20%

• A&E % response rate in July – 8.4% compared to a target of 20%.

There have been 2 Serious Incidents reported in July 2014 reported at Southport & Ormskirk Hospital NHS Trust relating to NHS Southport and Formby CCG patients, 14 incidents reported year to date. There has been 1 repeated incident reported year to date relating to 2x suspected suicides.

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2. Referrals The following section provides an overview of referrals to secondary care to July 2014. 2.1 Referrals by source Chart A Number of GP and ‘other’ referrals for the CCG across all providers for 2014/15. Referrals - Southport & Formby CCG 2014/15 6,000

5,000

4,000 2,013 2,219 2,089 2,314 3,000

2,000 Numberofreferrals 2,469 2,579 2,481 2,793 1,000

Apr-14 May-14 Jun-14 Jul-14 Period

Referral by General Medical Practitioner Referral by Other

Evidence suggests increase in GP referrals but overall referral in numbers remaining consistent. NHS Southport & Formby CCG to review Primary Care dashboard and explore referral activity by locality and practice. Chart B shows the number of GP and ‘other’ referrals for the CCG across all providers comparing 2013/14 and 2014/15 by month.

Referrals - Southport & Formby CCG 6,000

5,000

4,000

3,000

Numberofreferrals 2,000

1,000

Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Period

2014/15 - GP referral 2014/15 - Other referral 2013/14 - GP referral 2013/14 - Other referral 2014/15 - Total 2013/14 Total

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2.2 NHS Southport & Formby CCG patients waiting Chart C - Patients waiting on an incomplete pathway at the end of July 2014 by weeks waiting

Southport & Formby CCG patients waiting on Incomplete pathway July 2014 1000

900

800

700

600

500

400

300

200

100

0

00to01 Weeks 00to01 Weeks 01to02 Weeks 02to03 Weeks 03to04 Weeks 04to05 Weeks 05to06 Weeks 06to07 Weeks 07to08 Weeks 08to09 Weeks 09to10 Weeks 10to11 Weeks 11to12 Weeks 12to13 Weeks 13to14 Weeks 14to15 Weeks 15to16 Weeks 16to17 Weeks 17to18 Weeks 18to19 Weeks 19to20 Weeks 20to21 Weeks 21to22 Weeks 22to23 Weeks 23to24 Weeks 24to25 Weeks 25to26 Weeks 26to27 Weeks 27to28 Weeks 28to29 Weeks 29to30 Weeks 30to31 Weeks 31to32 Weeks 32to33 Weeks 33to34 Weeks 34to35 Weeks 35to36 Weeks 36to37 Weeks 37to38 Weeks 38to39 Weeks 39to40 Weeks 40to41 Weeks 41to42 Weeks 42to43 Weeks 43to44 Weeks 44to45 Weeks 45to46 Weeks 46to47 Weeks 47to48 Weeks 48to49 Weeks 49to50 Weeks 50to51 Weeks 51to52 52 Weeks Plus Weeks 52

There were 132 patients (2.1%) waiting on incomplete pathways at the end of July 2014 waiting over 18 weeks. There are no 52 week waiters present.

Top 5 Providers

Table 1 Patients waiting (in bands) on incomplete pathway for the top 5 providers.

Trust 0to10 wks 10to18 wks 18to24 wks 24to30 wks 30+ wks Total SOUTHPORT AND ORMSKIRK HOSPITAL NHS TRUST (RVY) 3903 495 69 9 1 4477

RENACRES HOSPITAL (NVC16) 462 158 0 0 0 620 AINTREE UNIVERSITY HOSPITAL NHS FOUNDATION TRUST (REM) 244 58 3 0 0 305 ROYAL LIVERPOOL AND BROADGREEN UNIVERSITY HOSPITALS NHS TRUST (RQ6) 259 58 15 3 7 342 ALDER HEY CHILDREN'S NHS FOUNDATION TRUST (RBS) 93 36 4 0 0 133

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3. Planned Care

3.1 All Providers Performance to Month 4 against planned care elements of the contract shows an over plan of £677k (6%). This is in the main driven by over performance at Southport & Ormskirk Hospital NHS Trust (£294k), Royal Liverpool and Broadgreen University Hospitals NHS Trust (£59k) and St Helens & Knowsley (£53k). Table 2 All Providers

Annual Activity Plan to Date Actual to date Variance to date Activity YTD Annual Plan Price Price Plan to Date Price Actual to Price variance to Price YTD % Provider Name Plan Activity Activity Activity % Var (£000s) (£000s) Date (£000s) date (£000s) Var Aintree University Hospitals NHS F/T 10,166 3,375 3,753 378 11.19% £2,239 £743 £819 £76 10.19% Alder Hey Childrens NHS F/T 4,509 1,512 1,681 169 11.17% £720 £250 £210 -£40 -16.09% Central University Hospitals Nhs Foundation Trust 0 0 102 102 0.00% £0 £0 £27 £27 0.00% Countess of Chester Hospital NHS Foundation Trust 0 0 30 30 0.00% £0 £0 £2 £2 0.00% East NHS Trust 0 0 4 4 0.00% £0 £0 £0 £0 0.00% Fairfield Hospital 61 20 29 9 42.62% £13 £4 £11 £7 159.63% ISIGHT (SOUTHPORT) 2,518 839 1,005 166 19.74% £582 £194 £247 £53 27.42% Liverpool Heart and Chest NHS F/T 1,243 412 459 47 11.52% £783 £259 £283 £24 9.43% Liverpool Womens Hospital NHS F/T 2,085 694 658 -36 -5.23% £730 £243 £240 -£3 -1.23% Renacres Hospital 7,308 2,436 3,346 910 37.35% £2,302 £767 £754 -£13 -1.73% Royal Liverpool & Broadgreen Hospitals 11,947 3,967 4,376 409 10.32% £2,636 £875 £935 £59 6.78% Southport & Ormskirk Hospital 103,405 34,379 44,641 10,262 29.85% £22,026 £7,376 £7,670 £294 3.99% SPIRE LIVERPOOL HOSPITAL 480 160 267 107 66.88% £128 £43 £62 £20 46.42% ST Helens & Knowsley Hospitals 3,540 1,154 1,332 178 15.47% £822 £269 £322 £53 19.69% University Hospital Of South Manchester Nhs Foundation Trust 191 64 53 -11 -17.65% £35 £12 £8 -£3 -29.25% Wirral University Hospital NHS F/T 0 0 93 93 0.00% £0 £0 £26 £26 0.00% , And Leigh Nhs Foundation Trust 1,927 642 900 258 40.11% £748 £249 £344 £95 38.13% 149,381 49,655 62,729 13,074 26.33% £33,764 £11,286 £11,963 £677 6.00% Above table is highlighting an over performance for Southport & Ormskirk Hospital year to date. However, a proportion of this over performance is reflected in the block contract and consequently this value is over stated. Further details are provided in the Finance report. An increase in day cases is evident at the Royal Liverpool and Broadgreen Hospitals NHS Trust and an increase in elective activity in St Helens and Knowsley Trust. The CCG needs to look at this in the context of Southport & Ormskirk Hospital elective and day case performance position. Both of these providers have outstanding contract queries in place relative to the above.

3.2 Southport and Ormskirk Hospital NHS Trust

Table 3: Month 4 Planned Care - Southport and Ormskirk Hospital

S&O Hospital Annual Activity Plan to Date Actual to date Variance to date Activity YTD Annual Plan Price Price Plan to Date Price Actual to Price variance to Price YTD % Planned Care PODS Plan Activity Activity Activity % Var (£000s) (£000s) Date (£000s) date (£000s) Var Daycase 12,058 4,038 4,198 160 3.96% £6,606 £2,219 £2,261 £42 1.90% Elective 1,851 625 558 -67 -10.78% £5,069 £1,721 £1,544 -£176 -10.26% Elective Excess BedDays 392 132 88 -44 -33.19% £90 £30 £21 -£9 -30.76% OPFAMPCL - OP 1st Attendance Multi-Professional Outpatient First. Attendance (Consultant Led) 1,054 350 447 97 27.73% £150 £50 £65 £15 30.39% OPFASPCL - Outpatient first attendance single professional consultant led 23,023 7,644 7,607 -37 -0.48% £3,355 £1,114 £1,085 -£29 -2.57% OPFUPMPCL - Outpatient Follow Up Multi-Professional Outpatient Follow. Up (Consultant Led). 2,156 716 930 214 29.92% £210 £70 £91 £21 30.47% OPFUPSPCL - Outpatient follow up single professional consultant led 48,179 15,996 18,445 2,449 15.31% £4,137 £1,374 £1,554 £180 13.12% Outpatient Procedure 14,692 4,878 11,894 7,016 143.83% £2,407 £799 £1,049 £250 31.25% Grand Total 103,405 34,379 44,641 10,262 29.85% £22,026 £7,376 £7,670 £294 3.99%

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Table 4: Month 4 Planned Care - Southport and Ormskirk Hospital 13/14 – 14/15 Comparison

Southport & Ormskirk Hospital 2014/15 Southport & Formby CCG Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar 1415 Activity Plan 953 953 1001 1131 Activity 1415 Activity Actual 1060 1022 1031 1085 Daycase 1415 Price Plan £522,238 £522,238 £548,350 £626,091 Price 1415 Price Actual £578,937 £565,688 £585,018 £586,711 1415 Activity Plan 146 146 154 179 Activity 1415 Activity Actual 140 151 125 142 Elective 1415 Price Plan £400,734 £400,734 £420,771 £498,505 Price 1415 Price Actual £360,736 £431,460 £343,770 £417,595

S&O Daycase - Activity S&O Daycase - Cost

1300 £700,000

1200 £650,000 £600,000 1100 1314 Activity Actual 1314 Price Actual £550,000 1000 1415 Activity Plan Cost 1415 Price Plan Activity £500,000 900 1415 Activity Actual £450,000 1415 Price Actual 800 £400,000

S&O Elective - Activity S&O Elective - Cost

190 £600,000 170 £500,000 150 130 1314 Activity Actual £400,000 1314 Price Actual

110 1415 Activity Plan Cost 1415 Price Plan Activity £300,000 90 1415 Activity Actual £200,000 1415 Price Actual 70 50 £100,000

3.3 Planned Care Key Issues 3.3.1 Southport and Ormskirk Hospital NHS Trust Further investigation into increases in A&E attendances and non-elective admissions. Joint discussions to take place between Trust and NHS Southport & Formby CCG and NHS West CCG as agreed at Contract and Quality Review meeting on the 3rd September 2014. Work will also be carried out between Cheshire and Commissioning Support Unit and the Trust to ensure activity and finance are being allocated to correct PODS across the contract avoiding any false values due to block items. 3.3.2 The Royal Liverpool and Broadgreen University Hospitals NHS Trust The Trust has been issued with an activity query notice relating to over-performance reported in Month 3. In keeping with the terms of the contract, a meeting has been arranged between the Trust and commissioners to discuss this issue (date to be arranged). The outcome of discussions will be reported in a future report.

4. Unplanned Care 4.1 All Providers Table E: Month 4 Unplanned Care - All Providers

Annual Activity Plan to Date Actual to date Variance to Activity YTD Annual Plan Price Plan to Price Actual to Price variance Price YTD % Provider Name Plan Activity Activity date Activity % Var Price (£000s) Date (£000s) Date (£000s) to date (£000s) Var Aintree University Hospitals NHS F/T 1,467 490 419 -71 -14.55% £826 £276 £286 £10 3.73% Alder Hey Childrens NHS F/T 664 222 243 21 9.67% £277 £94 £144 £49 52.57% Countess of Chester Hospital NHS Foundation Trust 0 0 9 9 0.00% £0 £0 £1 £1 0.00% East Cheshire NHS Trust 0 0 4 4 0.00% £0 £0 £0 £0 0.00% Liverpool Heart and Chest NHS F/T 157 53 41 -12 -22.72% £370 £124 £132 £8 6.57% Liverpool Womens Hospital NHS F/T 207 69 77 8 11.37% £179 £60 £58 -£2 -2.88% Royal Liverpool & Broadgreen Hospitals 1,285 430 380 -50 -11.53% £724 £242 £212 -£30 -12.22% Southport & Ormskirk Hospital 51,197 17,213 18,757 1,544 8.97% £26,149 £8,762 £9,492 £730 8.33% ST Helens & Knowsley Hospitals 292 99 146 47 46.94% £163 £56 £71 £15 27.06% Wirral University Hospital NHS F/T 0 0 26 26 0.00% £0 £0 £8 £8 0.00% Central Manchester University Hospitals Nhs Foundation Trust 0 0 42 42 0.00% £0 £0 £9 £9 0.00% University Hospital Of South Manchester Nhs Foundation Trust 47 16 12 -4 -24.78% £8 £3 £3 £0 10.59% Wrightington, Wigan And Leigh Nhs Foundation Trust 62 21 22 1 6.45% £53 £18 £8 -£9 -51.77% Grand Total 55,378 18,613 20,178 1,565 8.41% £28,748 £9,634 £10,427 £792 8.22% The CCG is currently reviewing non-elective activity at Southport & Ormskirk Hospital NHS Trust.

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4.2 Southport and Ormskirk Hospital NHS Trust

Table F: Month 4 Unplanned Care - Southport and Ormskirk Hospital NHS Trust

S&O Hospital Annual Activity Plan to Date Actual to date Variance to Activity YTD Annual Plan Price Plan to Price Actual to Price variance Price YTD % Urgent Care PODS Plan Activity Activity date Activity % Var Price (£000s) Date (£000s) Date (£000s) to date (£000s) Var A and E 32,878 11,247 12,026 779 6.93% £3,429 £1,173 £1,260 £87 7.43% Non Elective 10,554 3,444 4,004 560 16.25% £18,636 £6,202 £6,597 £395 6.36% Non Elective Non-Emergency 1,181 407 691 284 69.63% £1,947 £681 £733 £52 7.66% Non Elective Non-Emergency Excess Bed Day 169 96 45 -51 -52.94% £49 £26 £15 -£10 -40.38% Non Elective Short Stay 1,436 493 583 90 18.24% £995 £345 £389 £44 12.74% Non Elective Excess Bed Day 4,979 1,526 1,408 -118 -7.74% £1,093 £335 £312 -£23 -6.91% Grand Total 51,197 17,213 18,757 1,544 8.97% £26,149 £8,762 £9,307 £544 6.21%

Table G: Month 4 Planned Care - Southport and Ormskirk Hospital NHS Trust 13/14 – 14/15 Comparison

Southport & Ormskirk Hospital 2014/15 Southport & Formby CCG Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar 1415 Activity Plan 1092 1099 1035 1119 Activity Non-Elective 1415 Activity Actual 1307 1355 1299 1317 (NEL and NELST) 1415 Price Plan £1,816,601 £1,822,149 £1,721,693 £1,868,207 Price 1415 Price Actual £1,955,781 £1,991,101 £1,956,897 £2,001,245 1415 Activity Plan 2815 2745 2722 2965 Activity 1415 Activity Actual 2896 2983 2982 3165 AandE 1415 Price Plan £293,572 £286,319 £283,934 £309,222 Price 1415 Price Actual £306,334 £313,886 £314,958 £325,012

S&O Non-Elective - Activity S&O Non-Elective - Cost

1500 £2,500,000

1300 £2,000,000 1100 1314 Activity Actual 1314 Price Actual £1,500,000

900 1415 Activity Plan Cost 1415 Price Plan Activity 700 1415 Activity Actual £1,000,000 1415 Price Actual

500 £500,000

S&O A&E - Activity S&O A&E - Cost

3500 £350,000 3000 £300,000 2500 £250,000 2000 1314 Activity Actual £200,000 1314 Price Actual

1500 1415 Activity Plan Cost £150,000 1415 Price Plan Activity 1000 £100,000 1415 Activity Actual 1415 Price Actual 500 £50,000 0 £0

4.3 Unplanned Care Key Issues 4.3.1 Southport & Ormskirk Hospital Further investigation into increases in A&E attendances and non-elective admissions. Joint discussions to take place between Trust and NHS Southport & Formby CCG and NHS CCG as agreed at Contract and Quality Review meeting on the 3rd September 2014.

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5. Mental Health 5.1 Mersey Care contract The 2014/15 Expected Annual Contract Value for Mersey Care NHS Trust is £12,231,420 inclusive of CQUIN. A number of Contract Variations are being progressed and an updated Expected Annual Contract Value 2014/15 will be provided at Month 5.

Table H NHS Southport & Formby CCG – Shadow PbR Cluster Activity

NHS Southport and Formby CCG Variance Caseload PBR Cluster 2014/15 Plan from % Variance (May-2014) Plan 0 Variance 32 17 (15) -47% 1 Common Mental Health Problems (Low Severity) 35 37 2 6% 2 Common Mental Health Problems (Low Severity with greater need) 45 33 (12) -27% 3 Non-Psychotic (Moderate Severity) 162 167 5 3% 4 Non-Psychotic (Severe) 128 136 8 6% 5 Non-psychotic Disorders (Very Severe) 29 24 (5) -17% 6 Non-Psychotic Disorder of Over-Valued Ideas 25 20 (5) -20% 7 Enduring Non-Psychotic Disorders (High Disability) 96 119 23 24% 8 Non-Psychotic Chaotic and Challenging Disorders 62 73 11 18% 10 First Episode Psychosis 52 70 18 35% 11 On-going Recurrent Psychosis (Low Symptoms) 282 283 1 0% 12 On-going or Recurrent Psychosis (High Disability) 151 154 3 2% 13 On-going or Recurrent Psychosis (High Symptom & Disability) 105 109 4 4% 14 Psychotic Crisis 18 14 (4) -22% 15 Severe Psychotic Depression 7 5 (2) -29% 16 Psychosis & Affective Disorder (High Substance Misuse & Engagement) 6 6 - 0% 17 Psychosis and Affective Disorder – Difficult to Engage 35 32 (3) -9% 18 Cognitive Impairment (Low Need) 365 318 (47) -13% 19 Cognitive Impairment or Dementia Complicated (Moderate Need) 465 620 155 33% 20 Cognitive Impairment or Dementia Complicated (High Need) 159 203 44 28% 21 Cognitive Impairment or Dementia (High Physical or Engagement) 50 56 6 12% Reviewed Not Clustered 30 37 7 23% No Cluster or Review 46 98 52 113% Total 2,385 2,631 246 10%

5.1.1 Key Issues  Crisis Resolution Home Treatment and Assertive Outreach Teams – Reporting over performance, Activity Plan set at a national level.  ADHD Service - Sefton CCGs recurrently commissioned additional service capacity in 2013/14 to reduce the size of the Sefton commissioned ADHD service waiting list. Commissioners are monitoring waiting times, waiting list and DNAs.  Care Home In reach – Commissioners reviewing the current configuration of the service and service delivery model.  Rathbone Rehabilitation Service – 2 patients delayed discharge, one of which has been delayed since February 2013 awaiting suitable further placement and the second who is also currently delayed awaiting a financial appointee before they can be transferred.  Delayed Bed Days 199 Delayed Bed Days attributed to awaiting nursing home placement (122 days) public funding (30 days), patient/family choice (15 days) and Housing – patients not covered by NHS & Community Care Act (32 days) for Sefton Local Authority area at Month 4.

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5.2 Key Performance Indicator CPA follow up

Table I- NHS Southport & Formby CCG Performance CPA follow up within 7 days of discharge from psychiatric inpatient care

The Trust reports this KPI on a monthly basis but the consequence of the breach is based on the quarterly response. At Quarter 1 Mersey Care NHS Trust reported a catchment position of 98.3% which is above the threshold.

Table J NHS Southport & Formby CCG Performance CPA follow up within 2 days (48 hrs) for higher risk groups

5.2.1 Improving Access to Psychological Therapies (IAPT) Inclusion Matters Sefton Access to evidence-based psychological therapies is required to increase to 15% by Quarter 4 2014/15. We are currently reviewing the data from our provider around this measure. Providers of Improving Access to Psychological Therapies (IAPT) are expected to achieve a recovery rate of 50% by Quarter 4 2014/15. Inclusion Matters Sefton are reporting a recovery rate of 46.6% for NHS Southport & Formby CCG patients at Month 4.

Table K PHQ13_6 The Proportion of People who complete treatment who are moving to recovery

Completed Entered Below Moved to recovery Period (KPI5) Caseness (KPI6b) (KPI6) Recovery Apr-14 289 31 107 41.5% May-14 324 22 154 51.0% Jun-14 249 17 100 43.1% Jul-14 374 26 162 46.6%

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6. Liverpool Community Health Performance The 2014/15 Expected Annual Contract Value for Liverpool Community Health NHS Trust is £2,898,262 including CQUIN. A number of Contract Variations are being progressed and an updated Expected Annual Contract Value 2014/15 will be provided at Month 5.

6.1 Key Issues  The Trust has reported that over and under performances related to one of or a combination of factors; data quality issues relating to reporting onto electronic systems and staffing levels.  Cheshire and Merseyside Commissioning Support Unit have highlighted a number of issues relating to performance, non-reported activity against service lines and omitted services with the Contract Statement. They have been discussed with the Trust and issues are currently being addressed. 6.2 Third Sector Contracts  NHS Standard Contracts 2014/15 issued for signature. Cheshire and Merseyside Commissioning Support Unit are progressing sign off  Quarter 1 Activity Monitoring submissions are being reviewed and outstanding submissions progress chased  Commencement of Contract Review Meetings. The following issues have been raised so far; difficulties capturing electoral ward information, support required to complete NHS Information Governance Toolkit assessment and achievement of Level 2 Compliance. Support to address these issues is being discussed.

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7. Quality and Performance 7.1 Southport & Formby CCG Performance Dashboard

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Helping people to recover from episodes of ill health or following injury Patient reported outcomes measures for elective Eng Ave 2012/13 0.08 Refreshed data procedures: Groin hernia 0.085 Patient reported outcomes measures for elective Eng Ave 2012/13 0.43 Refreshed data procedures: Hip replacement 0.438 Patient reported outcomes measures for elective Eng Ave 2012/13 0.31 Refreshed data procedures: Knee replacement 0.318 Emergency readmissions within 30 days of discharge 14/15 - July 16.93 from hospital (Cumulative) Emergency admissions for children with Lower 14/15 - July 29.90 Respiratory Tract Infections (LRTI)(Cumulative) Emergency admissions for acute conditions that should 14/15 - July 578.81 not usually require hospital admission(Cumulative) SQU06_01 - % who had a stroke & spend at least 90% of 14/15 - July 80% 90.00% their time on a stroke unit (CCG) SQU06_01 - % who had a stroke & spend at least 90% of 14/15 - July 80% 84.62% their time on a stroke unit (Southport & Ormskirk) SQU06_02 - % high risk of Stroke who experience a TIA 14/15 - July 60% 100% are assessed and treated within 24 hours (CCG) SQU06_02 - % high risk of Stroke who experience a TIA are assessed and treated within 24 hours (Southport & 14/15 - July 60% 83.33% Ormskirk) Mental health Mental Health Measure - Care Programme Approach 14/15 - Qtr1 95% 97.67% (CPA) - 95% (Cumulative) (CCG) Preventing people from dying prematurely Under 75 mortality rate from cancer 2012 131.16 Under 75 mortality rate from cardiovascular disease 2012 67.21 Under 75 mortality rate from liver disease 2012 14.40 Under 75 mortality rate from respiratory disease 2012 24.59 Rate of potential years of life lost (PYLL) from causes Southport & Formby CCG achieved a rate of 2870.30 in 2012 2012 2,778.45 2,870.30 considered amenable to healthcare (Males) which failed the planned target of 2778.45 Rate of potential years of life lost (PYLL) from causes Southport & Formby CCG achieved a rate of 2160.50 in 2012 2012 2,091.36 2,160.50 considered amenable to healthcare (Females) which failed the planned target of 2091.36

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Cancer waits – 2 week wait Maximum two-week wait for first outpatient appointment for patients referred urgently with 14/15 - June 93% 97.56% suspected cancer by a GP – 93% (Cumulative) (CCG) Maximum two-week wait for first outpatient appointment for patients referred urgently with 14/15 - June 93% 97.19% suspected cancer by a GP – 93% (Cumulative) (Southport & Ormskirk) The CCG achieved 92.36% YTD marginally failing the 93% target. 7 out of 29 patients where not seen within 2 Maximum two-week wait for first outpatient weeks in June which shows 85.7% of patients where seen appointment for patients referred urgently with breast within 2 weeks. The main reason for breaching was 14/15 - June 93% 92.36% symptoms (where cancer was not initially suspected) – unable to attend/re-arranged consultations. All of the 93% (Cumulative) (CCG) patient's waiting over 2 weeks where seen within 20 days. 3 of the 7 patients where at Southport & Ormskirk Trust. Maximum two-week wait for first outpatient appointment for patients referred urgently with breast 14/15 - June 93% 96.05% symptoms (where cancer was not initially suspected) – 93% (Cumulative) (Southport & Ormskirk) Cancer waits – 31 days Maximum one month (31-day) wait from diagnosis to first definitive treatment for all cancers – 96% 14/15 - June 96% 99.53% (Cumulative) (CCG) Maximum one month (31-day) wait from diagnosis to first definitive treatment for all cancers – 96% 14/15 - June 96% 100% (Cumulative) (Southport & Ormskirk) Maximum 31-day wait for subsequent treatment where The CCG did not achive the 94% target, marginally failing the treatment is a course of radiotherapy – 94% 14/15 - June 94% 93.85% with 93.85% year to date. In month the CCG achived 100%. (Cumulative) (CCG) Maximum 31-day wait for subsequent treatment where the treatment is a course of radiotherapy – 94% 14/15 - June 94% 100% (Cumulative) (Southport & Ormskirk) Maximum 31-day wait for subsequent treatment where 14/15 - June 94% 97.44% that treatment is surgery – 94% (Cumulative) (CCG) Maximum 31-day wait for subsequent treatment where that treatment is surgery – 94% (Cumulative) (Southport & 14/15 - June 94% 97.22% Ormskirk) Maximum 31-day wait for subsequent treatment where that treatment is an anti-cancer drug regimen – 98% 14/15 - June 98% 100% (Cumulative) (CCG) Maximum 31-day wait for subsequent treatment where that treatment is an anti-cancer drug regimen – 98% 14/15 - June 98% 100% (Cumulative) (Southport & Ormskirk)

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Cancer waits – 62 days Maximum 62-day wait for first definitive treatment following a consultant’s decision to upgrade the priority 14/15 - June 89% of the patient (all cancers) – no operational standard set (Cumulative) (CCG) Maximum 62-day wait for first definitive treatment following a consultant’s decision to upgrade the priority 14/15 - June 88.24% of the patient (all cancers) – no operational standard set (Cumulative) (Southport & Ormskirk) Maximum 62-day wait from referral from an NHS screening service to first definitive treatment for all 14/15 - June 90% 100.00% cancers – 90% (Cumulative) (CCG) Maximum 62-day wait from referral from an NHS screening service to first definitive treatment for all 14/15 - June 90% 100% cancers – 90% (Cumulative) (Southport & Ormskirk) Maximum two month (62-day) wait from urgent GP referral to first definitive treatment for cancer – 85% 14/15 - June 85% 85.15% (Cumulative) (CCG) Maximum two month (62-day) wait from urgent GP referral to first definitive treatment for cancer – 85% 14/15 - June 85% 85.32% (Cumulative) (Southport & Ormskirk) Mixed Sex Accommodation Breaches The CCG had 6 breaches in July, all of the breaches relate Mixed Sex Accomodation (MSA) Breaches per 1000 FCE 14/15 - July 0.00 1.50 to Southport & Ormskirk Trust. No breaches recorded for (CCG) the previous 2 months. Mixed Sex Accomodation (MSA) Breaches per 1000 FCE The Trust had 6 Mixed Sex breaches in July, none in the 14/15 - July 0.00 1.00 (Southport & Ormskirk) previous 2 months. Referral To Treatment waiting times for non-urgent consultant-led treatment The number of Referral to Treatment (RTT) pathways greater than 52 weeks for completed admitted pathways 14/15 - July 0 0 (un-adjusted) (CCG) The number of Referral to Treatment (RTT) pathways greater than 52 weeks for completed admitted pathways 14/15 - June 0 0 (un-adjusted) (Southport & Ormskirk) The number of Referral to Treatment (RTT) pathways greater than 52 weeks for completed non-admitted 14/15 - July 0 0 pathways (CCG) The number of Referral to Treatment (RTT) pathways The Trust has 1 patient breach over 52 weeks, this is the greater than 52 weeks for completed non-admitted 14/15 - June 0 1 first breach in 2014/15. This was not a Southport & pathways (Southport & Ormskirk) Formby CCG patient. The number of Referral to Treatment (RTT) pathways 14/15 - July 0 0 greater than 52 weeks for incomplete pathways. (CCG) The number of Referral to Treatment (RTT) pathways greater than 52 weeks for incomplete pathways. 14/15 - June 0 0 (Southport & Ormskirk)

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Admitted patients to start treatment within a maximum 14/15 - July 90% 93.18% of 18 weeks from referral – 90% (CCG)

Admitted patients to start treatment within a maximum 14/15 - June 90% 92.99% of 18 weeks from referral – 90% (Southport & Ormskirk)

Non-admitted patients to start treatment within a 14/15 - July 95% 98.12% maximum of 18 weeks from referral – 95% (CCG) Non-admitted patients to start treatment within a maximum of 18 weeks from referral – 95% (Southport & 14/15 - June 95% 98.53% Ormskirk) Patients on incomplete non-emergency pathways (yet to start treatment) should have been waiting no more than 14/15 - July 92% 97.93% 18 weeks from referral – 92% (CCG)

Patients on incomplete non-emergency pathways (yet to start treatment) should have been waiting no more than 14/15 - June 92% 98.10% 18 weeks from referral – 92% (Southport & Ormskirk) A&E waits Percentage of patients who spent 4 hours or less in A&E 14/15 - July 95.00% 97.53% (Cumulative) (CCG) Percentage of patients who spent 4 hours or less in A&E 14/15 - July 95.00% 97.30% (Cumulative) (Southport & Ormskirk) Diagnostic test waiting times % of patients waiting 6 weeks or more for a Diagnostic 14/15 - July 1.00% 0.19% Test (CCG) % of patients waiting 6 weeks or more for a Diagnostic 14/15 - June 1.00% 0.08% Test (Southport & Ormskirk) Category A ambulance calls The CCG achived 62% in July and as such the year to date Ambulance clinical quality – Category A (Red 1) 8 minute 14/15 - July 75% 68.18% figure is also below target. Only in May was the monthly response time (CCG) (Cumulative) target achieved. The CCG achived 63% in July and as such the year to date Ambulance clinical quality – Category A (Red 2) 8 minute 14/15 - July 75% 67.11% figure is also below target. Only in May was the monthly response time (CCG) (Cumulative) target achieved. The CCG achived 90% in July and as such the year to date Ambulance clinical quality - Category 19 transportation 14/15 - July 95% 89.96% figure is also below target.Target yet to be achieved for time (CCG) (Cumulative) 2014/15. 68% was recorded in July, as such the year to date figure Ambulance clinical quality – Category A (Red 1) 8 minute 14/15 - July 75% 72.19% is below target. NWAS failed to achieved 75% for the past response time (NWAS) (Cumulative) 3 months. 69% was recorded in July, as such the year to date figure Ambulance clinical quality – Category A (Red 2) 8 minute 14/15 - July 75% 73.07% is below target. NWAS failed to achieved 75% for the past response time (NWAS) (Cumulative) 3 months. Ambulance clinical quality - Category 19 transportation 14/15 - July 95% 95.35% time (NWAS) (Cumulative)

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7.2 Friends and Family – Southport and Ormskirk NHS Trust

* Patient responses are used to calculate a ‘Net Promoter Score (NPS)’, a figure which is reported nationally. To work out the ‘net promoter score’, the number of detractors is subtracted from the number of promoters and then divided by the total number of responses. The score can therefore the score can be as low as -100 (everybody is a detractor) or as high as +100 (everyone is a promoter). A score between -100 and-50 is considered to be in the lowest quartile, -50 t0+50 the middle quartiles, and +50 to +100 the upper quartile. There is no literature on what is considered an acceptable NPS, but trusts usually aim for +50 or higher  Southport continues to score above the 15% CQUIN target for the combined response rate.  They continue to score above the 15% response rate for Inpatients  They continue to score below the 15% response rate in A&E.  Their net promoter score is in the upper mid quartile for A&E  The net promoter score is in the upper quartile for inpatients and for their combined results. Work is ongoing with the Trust to review Friends & Family Performance, at the CQPG in September the Trust advised they were liaising with Aintree Hospital to share their A&E good practice, in addition ‘incentivisation’ through AQC (Alternative Quality Contract) to introduce a text reminder service. 7.3 Complaints The Graphs below highlights Southport & Ormskirk Hospital’s number of complaints requiring investigation received by the Trust YTD compared to the same period last year. This information has gone to the Trust’s Board.

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The number of complaints received in July 14 was 27, similar to the 28 complaints received in June but 8 less than received in July 2013. Overall, for 14/15, the Trust has received 6% fewer formal complaints than were received for the same period in 13/14. The split of these complaints by Business Unit and Level is shown below.

Complaints to the Trust are dominated by those relating to clinical care, 44% of all complaints cite clinical treatment, although this has reduced significantly in July. Co-Ordination of medical treatment, poor nursing care and wrong diagnosis being the main reasons. Oral communication continues to be an area of concern within the Trust, with 8 complaints in July citing this as an issue, the highest number this financial year. Patients are complaining about a lack of clear explananation around treatment, diagnosis, and communication with family members. 19 complaints received between April and July contain issues around staff attitude. These relate to both Doctors and Nurses, including Agency Nurses. Trust action plans are being monitored via Quality & Safty Committee and at the Board.

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7.4 Serious Untoward Incidents (SUIs) 7.4.1 NHS Southport and Formby CCG 2 serious incidents reported in July 2014 relating to NHS Southport and Formby CCG patients, 14 incidents reported year to date. There has been 1 repeated incident reported year to date relating to 2x suspected suicides.

Table L Serious Untoward incidents NHS Southport & Formby CCG Patients by Trust

7.4.2 Southport and Ormskirk Hospital NHS Trust 1 serious incidents reported by the Trust in August 2014 affecting a NHS West Lancashire CCG patient. There have been 8 SUIs reported year to date, 2 of those categorised as never events (highlighted below in red).

Table M Reported Serious Untoward incidents - Southport and Ormskirk Hospital NHS Trust

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